Provider Demographics
NPI:1437552940
Name:GREENBRANCH DENTAL L.L.C
Entity Type:Organization
Organization Name:GREENBRANCH DENTAL L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-476-3432
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:WI
Mailing Address - Zip Code:54547-0146
Mailing Address - Country:US
Mailing Address - Phone:715-476-3432
Mailing Address - Fax:715-476-3418
Practice Address - Street 1:501 GRANITE ST
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1372
Practice Address - Country:US
Practice Address - Phone:715-561-2386
Practice Address - Fax:715-561-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6052122300000X
WI2279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty